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Case Management in a Chiropractic Office
Aug 4, 2008, 22:51

Chiropractic Case Manager Job Description Summary

In many chiropractic offices the majority of the attention on patient care is on the first 5 to 12 visits. In some offices, it is only on the first 5 visits, or less. It can get so bad that the primary concern is only on getting more and more new patient first visits. 

An old maxim in dental consulting is that the biggest cost to the dentist is the incomplete dental program. A patient who discontinues care after the first $1,000 of a total program of $10,000 just cost the dental office $9,000. This also applies to the chiropractic office.

Actually, many chiropractors are producing incomplete cases. This is not in the best interest of the patient’s health or in the viability of the office. Imagine a hygienist that only cleaned the upper teeth, or a baker that only baked his bread half way through. Yet, many offices are only getting their patients partially through their treatment programs.

The job of your clinic is to get your patients to complete their entire treatment program and on to a Wellness Program. During the course of a patient’s care, the doctor and staff may concentrate only on their specific duties with the patient, such as scheduling, treating (adjusting), collection, etc.  Usually no one has the job of overseeing the patient’s progress along the entire treatment pathway, through all the adjustments, scheduling, therapy, education, payments, until they finally “graduate” and go on to a Wellness Program.  

Yet a full Wellness Program takes some of the pressure off of the need for a constant stream of new patients and makes for a smooth running office.

To help ensure that patients get complete and comprehensive care, the position of Case Manager should be held by someone in the office.
Who should be the case manager: It can be fulfilled by the doctor, or the therapy or back office assistant, or the front desk or even the billing and collections staff member.

Time spent as a case manager: It should take no more than one hour per week.

Mission: The mission of the Case Manager is to ensure that all patients move through the various departments of a health care clinic smoothly and quickly, ensuring that they get excellent service such that they complete their treatment program as quickly as possible.

Duties and Responsibilities 

1.    Coordination. Once a week, or daily before treating hours, the case manager should get the doctor and essential staff together for a Case Management Meeting. A great time to do this is 20 minutes before the first patient for the day, or weekly for one hour. During this time, the appointment book or a list of active patients should be reviewed.

This is the most important tool the case manager (or case coordinator) has. During these meetings, the following points, among others, can be reviewed on each active patient:

  • Patient's Progress
  • Patient's Satisfaction
  • Re-exam (last/next)
  • Re-x-ray, or other diagnostics
  • Re-x-ray, or other diagnostics
  • Re-reports (progress report of findings)
  • Supplements
  • Exercises, nutritional or other recommendations
  • Financial conclusion (Initial, subsequent, and transitional to Wellness.)
  • Education programs, such as spinal care class, special lectures, pamphlets, etc.
  • Awards, compliments, thank you for referrals, good attendance, etc.
  • Family and friends referrals
  • Transition or adherence to a Wellness Program.
2.    Outcome and Statistics. Keep a statistic of “Completed Treatment Programs”. Once a patient reaches a maximum level of improvement they are ready to go on to Wellness Care. One way to keep this statistic is to track the number of patients beginning a wellness care program.

3.    Patient Progress Card. Make up a general treatment plan for every patient in the form of a simple checklist. This would include all service procedures, therapy, diagnostic, as well as educational actions. The last steps would include transitional consultations onto a wellness care program. This could be called a Patient Progress Card, and placed in the patient’s folder.

4.    Day 1 & 2 Procedures. Ensure that day one and day two procedures are well documented and kept up to date with current procedures, and a simple flow chart outlined.

5.    Regular Visit Procedures. Ensure that regular patient procedures are documented, and a simple flow chart outlined.

6.    Staff Training. Staff walk-throughs for day one and day two procedures, and other flow procedures rehearsed at least on a quarterly basis. The best offices practice monthly.

7.    Financial Consultations. Financial consultations done on all patients as often as is needed.

8.    New Patient Orientation. New Patient Orientation done on each patient.

9.    Patient Satisfaction. Ensured patients are very happy with service.

10.    Pathways. Pathways for different types of cases documented and reviewed by all.

11.    Flow Charts. Flow charts for first three day procedures outlined and rehearsed.

12.    Conversion. All patients completing services are converted to wellness or other programs.

Outcomes. The major outcome of the position of Case Manager is “Completed Treatment Programs.” That is, patients who have completed any acute or chronic treatment programs prescribed by the doctor and have reached maximum improvement. This definition could be extended to include: a patient who has completed their active care program and is educated so that they will continue onto a wellness program.”

Performance Monitors 
  • Number of Completed Treatment Programs
  • Number of Patients Beginning Wellness Care Programs
  • Number of Wellness Program Visits
It is easy to drop out important but not urgent actions with patients during their care. Ultimately, this leads to poor quality and a deterioration of results. With a Patient Progress Card, and the Case Manager System in place, quality and patient results will improve, and your volume will increase. Often it is not what we see that hurts us, but what we don’t see. It is the gradual omissions that eventually add up to an empty office. Ensure each patient completes all of the steps of their treatment programs.

For better patient retention, increased referrals, improved treatment compliance, and more revenue, implement the Case Management System! 

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